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Comfortably Numb: How Psychiatry Is Medicating a Nation By Charles Barber ( Pantheon )
Release Date: 2008-02-05
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Product Description
Public perceptions of mental health issues have changed dramatically over the last fifteen years, and nowhere is this more apparent than in the rampant overmedication of ordinary Americans. In 2006, 227 million antidepressant prescriptions were dispensed in the United States, more than any other class of medication; in that same year, the United States accounted for 66 percent of the global antidepressant market. In Comfortably Numb, Charles Barber provides a much-needed context for this disturbing phenomenon.
Barber explores the ways in which pharmaceutical companies first create the need for a drug and then rush to fill it, and he reveals that the increasing pressure Americans are under to medicate themselves (direct-to-consumer advertising, fewer nondrug therapeutic options, the promise of the quick fix, the blurring of distinction between mental illness and everyday problems). Most importantly, he convincingly argues that without an industry to promote them, non-pharmaceutical approaches that could have the potential to help millions are tragically overlooked by a nation that sees drugs as an instant cure for all emotional difficulties.
Here is an unprecedented account of the impact of psychiatric medications on American culture and on Americans themselves.
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 An Important Book ( paulocal )
Here, Barber has basically expanded his Winter 2008 Wilson Quarterly article entitled "The Brain: A mindless Obsession," into a full-length book. In the article he gives an excellent summary of the history and present status of the nation's mental heath system, including a history of the various therapies. Both are excellent, but the article is, arguably the more focused and robust. In it Barber takes us across the rather long and sordid history of the study and practice of mental illness: From the medieval practices and forms of treatments that led to electro-shocks and lobotomies (euphemistically referred to as psycho-surgey), to talk therapy, corporate dispensing of antipsychotic drugs, to the present field of brain-imagery.
The book focuses on one of the more important issues: How mental health is managed through drug and insurance company manipulation and thus it is about how mental illness has been "Corporatized," making the drug and insurance companies filthy rich and U.S. the most mentally ill of all nations - that is, if one is to judge national mental health by the number of doses of antipsychotic drugs dispensed per capita.
Now, the mentally ill are literally "turned out" from mental institutions onto the streets according to convenience of the insurance schedules and financial bottom lines. And then patients are administered drugs according to the drug company schedules and their financial bottom lines. Both have become multi-billion dollar industries as a result. It gives a whole new meaning to drug trafficking.
The problem with all of this is not just the built in cynicism of having a profit-driven health system run amok, mostly by the insurance and drug companies, but also the fact that scientists still do not seem to have a clue as to why antipsychotic drugs work?
Even the brightest light in a very dim field, the area of neuro-imagery, has a huge down side too: There is no one-to-one correspondence between brain mechanics and brain content, or thoughts.
The upshot of the book is that we don't know nearly as much about mental illness as we pretend to, and this lack of knowledge, when coupled with corporate greed, becomes a lethal combination that is likely to bring unintended surprises in the future.
Five stars for the article, four of the book.
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 Comfortably Numb
Comfortably Numb: How Psychiatry Is Medicating A Nation
Charles Barber
ISBN 978-0-375-42399-4
Charles Barber was educated at Harvard and Columbia and worked for ten years in New York City shelters for the homeless mentally ill. The title essay in his first book, Songs from the Black Chair, won a 2006 Pushcart Prize. His work has appeared in the The Washington Post, the New York Times and Scientific American Mind, among other publications, and on NPR. He is a senior administrator at The Connection, an innovative social services agency, and a lecturer in psychiatry at the Yale University School of Medicine. He lives in Connecticut with his family.
The experiences Barber shares are eye openers. Until I read this book, I didn't realize just how doctors were indeed over prescribing medications -- not that there are not real cases of mental health problems that benefit from medications, but should the same pill to help a real case of depression also be used for someone suffering an adjustment issue? I was surprised to learn that this is the case. Medication has an important role in the treatment protocol for severe metal health issues - schizophrenia and major depression, but we are lead to believe that drugs are an effective way to relieve the normal episodes of life, as well. The drugs may get you over the hump of occasional depressing days, but it will do little or nothing to help you learn ways to get over the humps without prescription drugs. This book confirms for me that it's easier for Americans to pop a pill than address the real issues.
With fast food, fast cars, and fast computers - it's no wonder we have settled for nothing less than a quick fix to the inevitabilities of life - losses, changes, etc. While many of us cope and work through the issues, there are some that would prefer to take a pill - quick relief being only a prescription away. And what is startling is that at least half of those in need of real assistance with real mental health issues are not receiving it. The physicians who are prescribing the quick fixes for normal adjustment issues remind me of a mechanic and their customer who has a flat tire - instead of the mechanic showing you how to change the tire or sending you to someone that can instruct you, he hands you a can of his special fix-a-flat-tire. Instead of learning to help yourself and getting the spare out of the trunk, rolling up your sleeves and changing the bloody thing, you whip out the can of the mechanic's special fix-a-flat-tire and you go on your marry way. However, the next morning, you're saddened to learn that once again your tire is flat - and the mechanic is closed. You have not learned to remedy life's flat tires and are totally dependant on the mechanic to solve your flat tire dilemma.
I also didn't know that "Americans account for two-thirds of the global antidepressant and psychiatric drug market," and "227 million antidepressant prescriptions were dispensed to Americans in 2006 - more than any other class of medication." In does not surprise me that in the fast paced nation we live in with the technology, food, and remotes, we would be depressed. We are alienated from each other - where are the days we spent with our family and friends instead of in virtual chat rooms and watching the latest reality show? A quick fix, easy solution and depressing.
I learned about the "little D" depression and the "big D" depression - one is in response to life's adjustments and the other is a mental illness. Both are frequently treated the same - medication, instead of using cognitive-behavior therapy or other alternative, non-medication approaches. It's has become the norm to take a pill for help over the humps of everyday life instead of learning to realize the triggers for our "little D" depression. But everyone seems to play along. The pharmaceutical companies make the happy pills, the doctor is happy to prescribe the happy pills, and the insurance companies are happy to pay for the happy pills. In one instance, an insurance company was happy to pay for a prescription - why not, since alternative therapy is more costly. Patients are less likely and may be less able to pursue therapy. Barber says, "...the vast majority of antidepressant prescriptions are written by family doctors." And, "as a result, after starting antidepressants and taking them for three months, ¾ of adults and over half of children do not see a doctor or therapist specifically for mental health care. Another report found that only 10% of people who take antidepressants have any kind of follow-up appointments to monitor the medication."
When I look at the homeless situation, I automatically think alcoholics and drug addicts. It rarely occurs to me that many of the homeless have serious mental health issues - and I never realized that many go untreated. When I learned that the "little D" depression was treated in the same manner as severe depression, I was appalled. Why should a homeless or less fortunate person not receive treatment for a mental illness - but the movie stars and college kids can get medications to get them over that last depressing movie or through the woes of college exams?
While pharmaceutical companies are skilled at marketing their wares, Barber ultimately blames the doctors - they are the ones who have taken an oath to "do no harm." And just how safe are these drugs being prescribed? "Major drug companies have been in the news for blatant violations." For example, "under a marketing campaign called "Viva Zyprexa." Eli Lilly pushed Zyprexa, indicated for biopolar and schizophrenia, on patients who did not suffer from either condition. The patients were actually suffering from dementia, a condition for which Zyprexa is not approved. In fact its use for dementia is warned against by the FDA, which has stated that Zyprexa can increase the risk of death for older patients with dementia-related psychosis. In the last few years, Lilly has paid $1.2 billion to settle claims for patients who said they developed diabetes or other diseases after taking the drug." And "Lilly is not alone."
This is a tough subject but Barber speaks out and tells it like it is - from experience. I highly recommend this book.
Sue Vogan
BookPleasures.com
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Missing the Logical Conclusion? ( gatsbyandphoebe )
There is much in this beautifully written book to commend it, especially the cautionary message of how risky and ill informed the rampant overmedication of emotional ills is in America -- and why it might be occurring. The discussion of alternative psychotherapies is inspiring and informed. Critics, including Peter Kramer, author of Listening to Prozac, who claim Charles Barber is exaggerating the true scope of the increase by using the dollar value of prescriptions that includes price increases as opposed to simple pill numbers seem to be missing the forest for the trees. Just ask your acquaintances. There is hardly a family in America that hasn't been touched by psychopharmacology. Almost every other person is on or has been on antidepressants or even stronger medications. There really is something wrong with this picture, as Barber astutely argues, given our lack of knowledge about how these drugs work, what their long term effects are, and the conflicts of interest that permeate drug research.
Given all this marvelous insight it's a disappointment that Barber doesn't take his analysis to its logical conclusion and realize treatments for serious mental illnesses are as flawed as those for minor ones. Barber gets very tangled up trying to distinguish between "true" mental illness and what he thinks are lesser disturbances. This is because he understands how ill informed treatment paradigms are for what he calls "little d" depression but somehow thinks all these same medications are just fine for "big D" Depression because he has observed them "work". Barber gets a lot of credit for speaking from firsthand experience with seriously disturbed individuals but in those whom he has seen return to functioning it is not clear he has attributed the cause to the right place. Every mental disturbance, whether it's serious or not, cannot be segregated from the story that precedes it. To do so is to be dismissive and arrogant; it marginalizes that person's suffering. Whatever one's genetic predisposition or ability to tolerate stress is, ultimately every mental illness is situational in one way or another. The only road to true healing is by dealing with that situation. This turns out to be even more important for serious mental illness -- mania and psychosis -- than it is for psychosocial ills. Medication alone can never "cure" mania and psychosis and may only exacerbate it over time.
Barber recently appeared on Fresh Air (NPR) and admitted to the astonishment of many, given his views, that he takes Prozac. Perhaps this is why he gets tangled up and doesn't really have an entirely consistent point of view on these medications. Maybe he hasn't been able to withdraw. He must believe he has a "true" mental illness yet he indicated in the interview that the way he took control of his OCD [Obsessive Compulsive Disorder] was through behavioral and lifestyle steps (i.e. the situation), not medication. Mental illness is on a continuum from minor to major; it is presumptuous to assume that there is some magic point on this continuum where suddenly it's all right to use possibly toxic and addictive medications even if they do provide a benefit due to their stimulant or sedative effect. While there are surely situations in which a psychotropic medication may be life saving over the short term, using them long term and dismissing the importance of situational issues is probably always dangerous, not just sometimes, as Barber implies.
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 Poison pill among sugared reviews ( andreicer )
I am not trying to take away from the importance of the book's subject, quality of author's prose, or the general conclusions that Mr. Barber makes about American society members' happy embrace of the magic pill as an istant solution to almost any problem life throws at them. However, I disagree with the author's liberal use of a key statistic - that "66 percent of the global antidepressant market was accounted for by the United States" - a phrase singled out and repeated on the cover jacket, and reviews, and thus removed even further from clarifying context. Given Mr. Barber's apparent knowledge of the subject matter, I believe he should have made clear that the quoted percentage is based on dollar sales, not patients or even prescriptions. As US prices for prescription medication are much higher than in the rest of the world, and IMS Health data (used as a source for the quoted percentage) most likely covers a handful of other major markets, besides US, the cited percentage creates the desired (?) sensational effect. For some readers, familiar with the pharmaceutical industry, this instance of biasing inaccuracy may undermine credibility of author's use of other numbers and facts to support his conclusions. It is a worthy read, nonetheless, as long as the reader is prepared to think critically and make up own mind.
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Clear insight
Barber gives a lucid account of how over the past fifty years our culture has embraced a pharmaceutical solution to what ails us. It's obvious he did his homework and knows what he's talking about from a researcher's standpoint. At the same time he poses a very convincing, hip perspective that resonates deeply with anyone who is willing to take a good, hard look at the evolution that has occurred resulting in the widespread acceptance of the medicating of our society. A great read.
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Addiction
